LIFETIME SOCIOECONOMIC POSITION AND MORTALITY - PROSPECTIVE OBSERVATIONAL STUDY

Objectives: To assess the influence of socioeconomic position over a l ifetime on risk factors for cardiovascular disease, on morbidity, and on mortality from various causes. Design: Prospective observational st udy with 21 years of follow up. Social class was determined as manual or non-manual at three stages of participants' lives: from the social class of their father's job, the social class of their first job, and the social class of their job at tile time of screening. A cumulative social class indicator was constructed, ranging from non-manual social class at all three stages of life to manual social class at all three stages. Setting: 27 workplaces in the west of Scotland. Participants: 5766 men aged 35-64 at the time of examination. Main outcome measures : Prevalence and level of risk factors for cardiovascular disease; mor bidity; and mortality from broad causes of death. Results: From non-ma nual social class locations at all thr-ee life stages to manual at all stages there were strong positive trends for blood pressure, body mas s index, current cigarette smoking, angina, and bronchitis. Inverse tr ends were seen for height, cholesterol concentration, lung function, a nd being an ex-smoker. 1580 men died during follow up. Age adjusted re lative death rates in comparison with the men of non-manual social cla ss locations at all three stages of life were 1.29 (95% confidence int erval 1.08 to 1.56) in men of two non-manual and one manual social cla ss; 1.45 (1.21 to 1.73) in men of two manual and one non-manual social class; and 1.71 (1.46 to 2.01) in men of manual social class at all t hree stages. Mortality from cardiovascular disease showed a similar gr aded association with cumulative social class. Mortality from cancer w as mainly raised among men of manual social class at all three stages. Adjustment for a wide range of risk factors caused little attenuation in the association of cumulative social class with mortality from all causes and from cardiovascular disease; greater attenuation was seen in the association with mortality from non-cardiovascular, non-cancer disease, Fathers having a non-manual occupation was strongly associate d with mortality from cardiovascular disease: relative rate 1.41 (1.15 to 1.72). Participants' social class at the time of screening was mor e strongly associated than the other social class indicators with mort ality from cancer and from non-cardiovascular, non-cancer causes. Conc lusions: Socioeconomic factors acting over the lifetime affect health and risk of premature death. The relative importance of influences at different stages varies for the cause of death, Studies with data on s ocioeconomic circumstances at only one stage of life are inadequate fo r fully elucidating the contribution of socioeconomic factors to healt h and mortality risk.